Unraveling the Intricacies: Integrated and Enhanced Surveillance and Epidemiology for HIV, Syphilis, and Related Co-Infections Under the National AIDS and STD Control Programme in India.

BACKGROUND

Integrated and Enhanced Surveillance and Epidemiology (IESE) framework is a key surveillance tool for monitoring the level and trends of the human immunodeficiency virus (HIV) and related co-infections in the country.

OBJECTIVES

This paper describes the level and trends of the human immunodeficiency virus (HIV) epidemic in the country, along with the sero-prevalence of the related infections based on the various surveillance surveys and disease burden activities undertaken under the IESE framework.

MATERIALS AND

METHODS

HIV sentinel surveillance (HSS) monitors the prevalence of HIV, Syphilis, hepatitis B, and hepatitis C in eight population groups through periodic facility-based surveys. The collected data is then used in estimating the HIV burden using a globally used modeling tool. Here, we present the results from the latest round of HSS and HIV disease burden estimation to highlight epidemic status by location and population.

RESULTS

In 2023, adult HIV prevalence was 0.20% nationally, with a 44% drop in annual new infections and a 79% drop in acquired immune deficiency syndrome (AIDS)-related deaths since 2010. The incidence-prevalence ratio was 2.69, and the incidence-mortality ratio was 1.15 in 2023. The proportion of people living with HIV (PLHIV) aged 50+ among total PLHIV increased from 17% in 2000 to 37% in 2023. Two states and 29 districts had over 1% prevalence, with rising new infections in six states/union territories: Tripura, Arunachal Pradesh, Meghalaya, Punjab, Dadra and Nagar Haveli and Daman and Diu, and Assam. HIV prevalence ranged from 0.89% among migrants to 9.03% among people who inject drugs (PWID). Among HIV-positive individuals, syphilis sero-positivity was between 1% and 1.84%.

CONCLUSION

The HIV/acquired immune deficiency syndrome (AIDS) epidemic in India remains low nationally, with new infections and AIDS-related deaths declining faster than global averages. However, certain states and key populations are experiencing a rising epidemic, potentially due to injecting drug use and casual heterosexual risk behavior. The high prevalence of co-infections necessitates integrated care to reduce morbidity and mortality among those infected.